Advanced Electrosurgical Bipolar Vessel Sealing to Control Intraoperative Bleeding in Hysterectomy: A Rapid Review and Meta-Analysis
Notice bibliographique
Résumé
Background: Controlling intraoperative bleeding during hysterectomy is crucial and various methods exist to do this. Advanced electrosurgical bipolar vessel sealing (ABVS) may lead to improved outcomes compared to other hemostatic techniques. This rapid review aims to address the question “what is the clinical and cost effectiveness of ABVS compared with standard care for controlling intraoperative bleeding in hysterectomy?” Methods: Medline, Embase, CINAHL, KSR Evidence, Cochrane Library, and the International Network of Agencies for Health Technology Assessment (INAHTA) HTA database were searched up to February 2025. Forward citation searching of included studies was conducted in Scopus. Systematic reviews and randomized controlled trials (RCTs) comparing ABVS to standard care for controlling intraoperative bleeding during abdominal, laparoscopic, or vaginal hysterectomies were included. Outcomes extracted included blood loss, operative time, complications, length of hospital stay, patient-reported pain, blood transfusions, health-related quality of life, resource use, and economic outcomes. Meta-analyses were conducted for each type of hysterectomy and pooled effect sizes were analyzed. Studies were synthesized narratively if not included in meta-analyses. Results: One systematic review, one HTA, and 15 RCTs met the eligibility criteria. Meta-analyses found statistically significant differences in favor of ABVS over suturing for vaginal hysterectomy operative time and patient-reported pain the evening after surgery, abdominal hysterectomy blood loss and risk of requiring blood transfusion, and in favor of ABVS over conventional electrosurgical bipolar vessel sealing for total laparoscopic hysterectomy operative time. Two studies showed significantly lower blood loss with ABVS during subtotal laparoscopic hysterectomy. There were no statistically significant differences in other outcomes. A cost-consequence analysis from the UK perspective demonstrated high upfront costs associated with ABVS; however, potential cost savings were associated with reduced suture usage and lengths of hospital stay. Conclusions: Use of ABVS during hysterectomy may lead to some improved outcomes compared to suturing or other energy devices; however, many outcomes are similar between methods. A lack of economic evidence means economic consequences are uncertain. Use of ABVS should be based on the type of hysterectomy performed, complexity of individual patients, and surgeons’ familiarity with devices.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».